Question

please help

Please help to give me 1 case study and some question about Respiratory Failure.

please typing

Answer 1

A 68-year-old man with a past medical history of hypertension, hemorrhagic stroke, and tobacco use and a family history of coronary artery disease was convalescing at an adult family home after a recent hospital admission for community-acquired pneumonia when he was noted to develop acute dyspnea. On arrival at his residence, the paramedics found the patient moaning, with a Glasgow Coma Scale score of 8 and increased work of breathing.

On arrival at the emergency department, his temperature was 36.28C; heart rate, 47 beats/minute; blood pressure, 97/56 mm Hg; respiratory rate, 36 breaths/minute; and he had an oxygen saturation of 70% while he breathed oxygen via a nonrebreather mask. The patient was intubated on an emergency basis. Physical examination after intubation

and initiation of sedation revealed a well- nourished, unresponsive man. The trachea was midline and lungs were clear to auscultation. Cardiac examination revealed regular bradycardia, no precordial heaves, and a grade III/VI holosystolic murmur along the left sternal border, which had
not been noted during his previous hospitalization. There were diminished dorsalis pedis and radial pulses and his skin was cool to palpation. The abdomen was soft, nontender, and without organomegaly. There was no asymmetric lower extremity edema.

anteroposterior chest radiograph (Figure 1) and an electrocardiogram (Figure 2) were performed. Computed tomography (CT) imaging of the head revealed, without injection of contrast dye, revealed no acute abnormality.

In the emergency department, the patient became progressively bradycardic and hypotensive. He was administered atropine in divided doses, 4 L of crystalloid solution, and was started on norepinephrine and sodium bicarbonate infusions.
Bedside ultrasonography was performed and revealed a severely dilated right ventricle with flattening of the interventricular septum.

Arterial pH and Blood Gas Tensions (FIO2; Value PEEP 5 cm H2O)

1. What is the likely diagnosis?

2. What additional diagnostic data may be useful?

3. What is the appropriate initial management?